Healthcare Provider Details

I. General information

NPI: 1396751541
Provider Name (Legal Business Name): HARRY MARSHAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR #300
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-7600
  • Fax:
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG57467
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG57467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: